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Shoulder: Frozen Shoulder

Eighteen months ago I had an operation on my shoulder for Os acromialis. Although initially good, it became aggravated after I started climbing several months later. My range of motion became extremely restricted and the shoulder very painful. Sleep was almost impossible. It was subsequently diagnosed as frozen shoulder. I’ve done loads of PT, haven’t climbed in eight months, and am not happy. My docs say, “If it hurts, don’t do it.” I know I’m definitely on the upswing, but am wondering when I should try to climb some mellow stuff. About once a week I try to do a push-up—it’s possible, but doesn’t feel great. I don’t think I could do a pull-up without wincing.

— KOLIN POWICK | SALT LAKE CITY, UTAH

Frozen shoulder is like a bad relationship: painful, too long and, for the avid rockateer, soul destroying. Technically known as adhesive capsulitis, it is considerably less understood than the dynamics of human love.

For reasons largely unknown, the capsule that surrounds and supports the shoulder joint becomes inflamed, causing fibrous bands to form within. Consequently, the range of motion becomes severely restricted.

On average, you are looking at a couple of years of pain and frustration. There are three conveniently named stages: freezing, frozen and thawing.

The process typically starts with a minor shoulder injury and progresses within weeks to involve adhesive capsulitis. Difficult to say whether you had it originally (in its early stages) and it was missed, or whether the surgery was the catalyst, as can often happen.

As the joint progressively stiffens, the party gets underway, capsulitis is joined by its brothers-in-arms-—synovitis and tendonitis. Like any good ménage à trois, sleep is impossible and exhaustion guaranteed.

If the condition is caught in the first couple of months, it is possible to swing the obstinate tide of restriction (and pain) with very aggressive range of motion therapy. I’ve not seen it reversed from a fully frozen state using manual therapy alone, though there are practitioners who say they have done it.

Hydrodilatation is the next option, and involves forcing a cocktail of pharmaceuticals into the joint cavity in order to stretch the capsule. In conjunction with aggressive stretching in the days that follow the injection, this protocol can be very effective.

As the name suggests, manipulation under anaesthetic (MUA) is more akin to psychopathic S&M than brilliant medicine. For medicos, like politicians, brutality is always an option.

Both the hydrodilatation and MUA are not for you, as it sounds like you are in the thawing phase. This may take six months, during which time you should regain the vast majority of your range of motion.

I would agree with your doc so far as pointless aggravation is unhelpful. However, encouraging range of motion and building strength are integral components of any rehab program. Neither comes pain free.